TY - JOUR AU - Гончарова, Ольга AU - Архипкіна, Тетяна AU - Любимова, Лідія PY - 2022/06/09 Y2 - 2024/03/28 TI - OBESITY IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME. PATHOGENETIC ASPECTS AND PERSPECTIVE DIRECTIONS OF THERAPY JF - Problems of Endocrine Pathology JA - PEP VL - 79 IS - 2 SE - DO - 10.21856/j-PEP.2022.2.15 UR - https://www.jpep.endocrinology.org.ua/index.php/1/article/view/997 SP - 105-111 AB - <p>Polycystic ovary syndrome (PCOS) is a common endocrine disorder with a complex multifactorial pathogenesis, largely associated with android-type obesity (Ob). Ob and overweight, which occurs in 50-80 % of PCOS patients, not only affects overall health but also impairs reproductive function, steroid metabolism with increased levels of free androgens, and due to peripheral androgen conversion - and an increase in estrogen levels. Androgens increase lipolysis with the accumulation of additional free fatty acids and the development of atherogenic dyslipidemia. Almost 90-100% of patients with Ob have insulin resistance (IR), against which develops compensatory hyperinsulinemia (GI). In general, Ob, IR, and secondary GI affect the full range of disorders associated with PCOS. Therefore, an important step in the treatment of PCOS is to reduce the total mass of adipose tissue, and in this, in addition to lifestyle modifications, the leading role is played by drug therapy. Today, the most common used drug in the treatment of reproductive pathology in women with PCOS and Ob in the presence of IR is metformin. Literature data and practical experience conducted at the clinic of IPEP with a survey of 128 women with the classical phenotype of PCOS and Ob by android type, GI and IR indicate that metformin therapy leads to lower serum glucose, increased sensitivity of peripheral tissues to insulin improving the lipid spectrum of the blood, lowering triglycerides, increasing the globulin that binds sex hormones, reducing hyperandrogenemia. At the same time, there was just a tendency to reduce the body mass index, waist-to-hip ratio and the specific gravity of fat. That is, the effect of metformin on weight loss and adipose tissue distribution was insufficient. For today, it is considered appropriate to use glucagon-like peptide 1 (GLP-1) agonists in patients with PCOS with Ob and IR, which lead to a more significant decrease in body mass index and waist circumference compared to metformin. There are data on a significant improvement in metabolic and hormonal parameters, as well as the restoration of menstrual cycles after the use of combination therapy with GLP-1 agonist and metformin. This combination also makes it possible to use lower doses of both drugs, which is not accompanied by a significant difference in the frequency and severity of possible side effects compared with monotherapy with GLP-1 agonist or metformin.</p> ER -